NPIMap

Organization Active NPI

Computerx Pharmacy Inc

Doing business as ComputeRx Pharmacy IV

  • Durable Medical Equipment & Medical Supplies
  • Stratford, CT
National Provider Identifier
1174505036
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
1524 Issued in CT
Legal business name
COMPUTERX PHARMACY INC
Doing business as
ComputeRx Pharmacy IV
Practice address
35 Ontario St
Stratford, CT 06615-7135
Phone
(203) 375-8000
Fax
(800) 784-5430
NPI assigned
Nov 16, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Michael William Licamele, PHARM. D.NPI 1366424715
Title
Cheif Executive Officer
Phone
(203) 375-8000

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 1524 CT Primary

Addresses

Primary practice location

35 Ontario St
Stratford, CT 06615-7135

Mailing address

35 Ontario St
Stratford, CT 06615-7135
Phone (203) 375-8000

Other identifiers 12

IdentifierTypeStateIssuer
9003226900MedicaidKY
0076567170003MedicaidPA
7419007MedicaidNJ
81195000MedicaidWI
9126431MedicaidVA
7419015MedicaidNJ
0076567170002MedicaidPA
2332587MedicaidOH
02620148MedicaidNY
4645110MedicaidMI
852021MedicaidAZ
XDME03019MedicaidCA

Other names 1

  • ComputeRx Pharmacy IV Doing business as

National Provider Directory

National Provider Directory

Locations

35 Ontario St
Stratford, CT 06615
Phone (203) 375-8000

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174505036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 ONTARIO ST",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066157135",
            "telephone_number": "203-375-8000",
            "fax_number": "800-784-5430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 ONTARIO ST",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066157135",
            "telephone_number": "203-375-8000",
            "fax_number": "800-784-5430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPUTERX PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LICAMELE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "CHEIF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "203-375-8000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARM. D."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CT",
            "license": "1524",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9003226900",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0076567170003",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7419007",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "81195000",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9126431",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7419015",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0076567170002",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2332587",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02620148",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4645110",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "852021",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "XDME03019",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ComputeRx Pharmacy IV",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stratford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.